We present the case of a 42-year-old woman with a history of
Systemic Lupus Erythematosus (SLE) from the age of 18 and CKD
that progressed to ESRD leading initially to a living non-related
kidney transplantation at the age of 31 and followed by patient
induction to Continuous Ambulatory Peritoneal Dialysis (CAPD)
at the age of 38, due to failing graft. The patient was referred
to our hospital with bilateral leg ulcers, initially described
as painful erythematous plaques. Over the past months, her
peritoneal dialysis clearance was inadequate and progressively
she experienced very high levels of urea, but despite her doctors’
recommendations, she had refused a switch to hemodialysis
(HD). On examination, she was clearly cachectic, anxious and in
extreme pain, but hemodynamically stable and afebrile. There
were extensive ulcers on her legs with necrotic eschars (Figure 1).